Inoue Hiroshi, Motohashi Tomokazu, Ioku Yusuke, Watanabe Masahiro, Nakajima Masahiro, Sugitatsu Mitsuchika
Department of Dentistry and Oral Surgery, Osaka Red Cross Hospital, 5-30 Fudegasakicho, Tennoji-ku, Osaka, 543-8555, Japan.
Second Department of Oral and Maxillofacial Surgery, Osaka Dental University, 1-5-17 Otemae, Chuo-ku, Osaka, 540-0008, Japan.
IDCases. 2020 Jan 11;19:e00700. doi: 10.1016/j.idcr.2020.e00700. eCollection 2020.
Cryptococcus is a mycosis founded in immunocompromised patients. Cryptococcus in the oral cavity is rare and skeletal infection is uncommon. We report the case of a 31-year-old man in whom cellulitis developed due to infection after tooth extraction complicated by acute myeloid leukemia (AML). Cellulitis of the left mandible did not improve after conservative therapy, including antimicrobial therapy, because of AML and chemotherapy, and gas was generated in the left cervical and supraclavicular regions. We considered the infection symptoms to be life-threatening, and surgery was performed for the infection of the head and neck under poor general conditions. As histopathological examination of the removed tissue revealed cryptococcus, antifungal agents were administered for cryptococcal infection. The surgical site healed after the operation. Surgical treatment, including debridement and drainage, should be avoided for patients with a poor general condition caused by AML and chemotherapy. However, the detection of Cryptococcus in the surgical site in such a condition is important.
隐球菌病是一种在免疫功能低下患者中发现的真菌病。口腔隐球菌感染罕见，骨骼感染也不常见。我们报告一例31岁男性病例，该患者因拔牙后感染并发急性髓系白血病（AML）而发生蜂窝织炎。由于AML和化疗，包括抗菌治疗在内的保守治疗后，左下颌骨蜂窝织炎未见好转，且左颈部和锁骨上区域出现气体。我们认为感染症状危及生命，因此在全身状况较差的情况下对头部和颈部感染进行了手术。由于切除组织的组织病理学检查发现隐球菌，因此给予抗真菌药物治疗隐球菌感染。术后手术部位愈合。对于因AML和化疗导致全身状况较差的患者，应避免进行包括清创和引流在内的手术治疗。然而，在这种情况下，在手术部位检测到隐球菌很重要。
